We are the Association for Child and Adolescent Mental Health or ACAMH for short. And this is ACAMH Learn. Hello there, and welcome to Mind the Kids. I'm Dr. Jane Gilmour, honorary consultant, clinical psychologist and child development programme director at UCL. And I'm Umar Toseeb a professor of psychology at the University of York focusing on children and young people's mental health and special educational needs. In each episode of Mind the Kids, we select a topic from the research literature and in conversation with invited authors, sift through the data, dilemmas, and debates to leave you with our takeaways for academics and practitioners. Today, we'll be discussing the impact of poverty and family life and exploring why some children beat the odds. This episode is called "Incom(ing)-- Poverty and Resilience." So let's talk about child poverty. So this is a really, really interesting topic, because I think it's topical in the political spheres in the UK at the moment with the labour government, who have been in power just over a year. And I think there was some controversial things that-- no, wait. It's not even controversial as in like we have a limit in the UK which is something like, what is it like if you have more than two children, you can't access certain state benefits. And that restriction is thought to be-- is it a driver of child poverty or if it was scrapped, it would be the single biggest thing we could do as a policy to reduce child poverty? It's one of the two, which is, I think, why certain parts of society are pushing for it because it would help to reduce child poverty. And so I tried to do a bit of reading about what child poverty is before this podcast. And I think we can think of it as relative child poverty. So that's when we compare the household income with other households and see whether it's below a certain value. And then absolute child poverty, which is just absolute household income, I think the kind of statistic we're looking at is about one in three children live in poverty, which is a really high number. That's a lot of children. It's pretty shocking to think about that. And I really like the way you were highlighting the difference between relative and absolute poverty, because it's one of the issues that we were drawn towards in the paper that we're about to discuss, the idea of salience of the experience of poverty. So if you're sitting in a relatively well-resourced environment and you have a significant amount of deprivation, that emotional experience might be greater. And the other thing, of course, the idea of poverty in and of itself, with all of the challenges that we are about to discuss, is a very pertinent point. But from a mental health point of view, we know that poverty is very much linked to mental health issues. So children from the poorest 20% of households are four times more likely to experience mental health problems by the age of 11 than those in the wealthiest 20%. And then add on the COVID effects where families are vulnerable and there's an issue that increases or decreases life chances. COVID exacerbated that effect. As you say, it's a really pertinent and topical point to be discussing in the context of mental health and humanity, as it were. Yeah, and I think what's interesting also for me is that things did get better. And now, they seem to have got worse. So again, I was looking at some statistics and I think it was from the IFS. Is that the Institute for Fiscal Studies? So between 1997 and 2010, there was a decrease in relative child poverty. And then it stayed stable until about 2014, 15-ish. And then it's risen since to about figures that we have now, which is around one in three. So it's interesting how in the recent past as a country, we did do well to reduce it. And it still wasn't at acceptable levels, but it was going in the right direction. And now, it's become more of a problem again. It's something that we have to think about and address, but it's also something that I think is important. And we sometimes on this podcast, we talk about our personal experiences of maybe being in an experience of poverty or observing an experience of poverty. And I think it really made me think about the variety of impacts that poverty can have on a young person and their family. I grew up really in a very privileged situation. And I don't think I had really faced the experience of poverty very well until I gathered my PhD data. So I was recruiting families that were living in extreme socioeconomic deprivation and chronic stress. And so doing my data collection meant that my PhD was an education, a proper education in the truest sense, because I started to be introduced to the ideas of the environmental experience of living in poverty. So, for example, I was doing data collection and I got to the edge of an estate. I was in a cab ready to go and do a home visit. And the cab driver said, see you later, pal. Out you get. I don't go any further. I don't go into this estate. So walking past houses that were bricked up or burnt out cars is the experience that families have day to day if they're living in that environment. There's societal experiences, the material pressure on goods. So families that were giving their kids their Christmas presents before Christmas Day because they'd got a grant to do that and the parenting challenges, those additional challenges that parents have. So if you have a child living these stressful circumstances, they're going to have certainly some of those young people. And it's going to require an additional level of support from parents and those parents are already vulnerable. But I think what really stood out-- and it's pertinent to this paper and it really speaks to the idea-- is that I could certainly see from informal observation and also from some of the formal assessments I did. So for example, I measured expressed emotion which is, to a degree, a family functioning measure. And I could see that some families were coping and had a much better outcome despite being in similar geographical and economic circumstances. So I think that was really interesting, thinking about why some kids were beating the odds or why some families were beating the odds, and what those mechanisms were and how we can learn from that to develop ideas and interventions. And I mean moving on to how we see young people who have experienced poverty in our day-to-day lives, I think, well, in our professional lives, I think, as working at a university maybe about a decade ago, I would say that you could see that the students who didn't come from money were the ones who were missing lectures, because they had to have part-time jobs so they could stay afloat. If they had caring responsibilities, they might be more likely to commute from home or their parents' home because they didn't live in student halls or student accommodation. But now, I mean, I think that's less so it seems that all students are now taking on part-time jobs, more likely to commute, et cetera. But definitely in the past, it was those who had experienced poverty who were the ones who were most likely to work as well as study. And then work patterns meant they missed education. So these practical barriers to thriving just pile up from day one or before day one for students or young people or children or families who are vulnerable in terms of their economic experiences. And it really does when one looks at the data. And we'll have an opportunity to get an expert voice in a moment. But when one looks at the data, the breadth and the depth of the impact is somewhat overwhelming, I think. And it does invite us to just take one step at a time. Because if we look at all of the potential impacts and all the potential relationships starting from day one. In a young person's life, I think it might feel that there's too much to do. But in fact, if we unpack it, there's lots of things, I think, that we can start to consider in terms of intervention. But we will get an expert view on that, I suspect. Yes, let's do it. Let's introduce the guest. Today we're joined by Dr. Divyangana Rakesh from King's College London. Divyangana is the lead author of the paper "Beyond the income achievement-gap-- the role of individual, family and environmental factors in cognitive resilience among low-income youth," which is published in the JCPP Advances. Welcome. Hi. Thank you for having me. Thank you so much for agreeing to have this chat with us. Let's just start by just thinking about some of your motivations for doing this kind of work. So why is it important for you to investigate the relationship between poverty and achievement and why now? So personally-- and I guess there's two different reasons. One is I grew up in India, so I got to see-- although I grew up in a middle-class household, you get to see a lot of poverty. And you see that intergenerational transmission of poverty and that cycle is really hard to break. So that's where I came from. And I was just trying throughout my PhD and beyond to find factors that can break that cycle. And then there is the reading that I did because I was interested in this and saw it. And some of those numbers that you've quoted about child poverty rising, we have massive increases in inequality happening since the '80s across OECD countries, even in the more egalitarian societies as well but particularly in the US and the UK. And then you have, of course, abject poverty and extreme deprivation in the Global South, in India, and Bangladesh and other countries like that that I visited. Growing up and seeing what I did and then reading more about it and trying to understand how do we actually break that intergenerational transmission of poverty. And then the pandemic happened, which is what you also wrote up and that exacerbated these inequalities further. I haven't dug too much into that, but we know that that's happened. So a mix of all of these things, and I think that's what makes it really important, at least for me personally, to study and study it now. And we started to touch on this idea of the breadth and the depth of the variables that one must consider and explore and understand when you're thinking about poverty. But one of the things you were talking about was focusing on attainment and achievement and executive function in particular, which I'm sure I'll ask you to explain for those that are not familiar with what executive function means. Can you explain a little bit about one of the key ways that we can see poverty might impact on educational outcome just in a very broad sense? Yeah, so I mean, another thing that I should have brought up in the previous response that I'll bring up now is the fact that the gap in achievement between children who grew up in poor backgrounds and children who don't has existed and persisted for decades. So there's been a fair bit of money that's been put in. For example, in the United States, you have the Early Head Start programme. You have similar things that have happened in different countries. But that gap has not reduced. So children who grow up in poor backgrounds, poor households, they tend to have lower achievement. And one of the ways in which we think that happens is executive function. So executive function is something we think poverty impacts. And we can get into why that might be and what are the factors that promote that. But executive function is basically the brain's ability and control processes so working memory so being able to hold multiple things in your mind at once, inhibitory controls so being able to inhibit inappropriate responses as well as being cognitively flexible. So these things allow children to actually pay attention to do what is asked of them, hold information in their mind. And you can imagine that all of this is really important for achievement. So if poverty is impacting executive function and you're expecting kids to sit in a classroom, follow instructions, persist in their tasks, you can imagine that something like executive function can impact learning across a breadth of subjects like reading, mathematics, science, language, whatever you may call it. So that's essentially one of the ways in which we think poverty can impact achievement. It impacts some really important cognitive functions like executive function or EF. So I can understand why I can follow the rationale that executive function impacts upon educational attainment and children's participation and engagement with school. I can't see the pathway from poverty to executive function. Can you just unpack that a bit for us? Why would poverty impact on executive function or how? Well, that's what we've been trying to do for decades and find out why. So you've hit the nail on the head. But the truth of the answer is that although we don't completely understand, we know that it has an impact on the brain. So poverty can impact the brain in a few different ways. And we think the brain then acts as a pathway or mediator, linking poverty to executive function and other cognitive outcomes. And so what is it about poverty? I guess that's what we're getting at. What are the different factors of poverty? So the first, I think, would be the physical environment. So children who, again, grow up in poor households, their nutrition is different. The physical environment in terms of exposure to perhaps noise and toxicants, pollution, all of that is different. Because often if you don't have money coming in, you're not able to afford living in a rich, privileged neighbourhood. And industrial sites are often close to disadvantaged areas so you have a lot of these physical things that can directly impact the brain. Then we have the social environment. And this talks about the old frameworks of the family investment model or the family stress model. And again, this is through no fault of their own. Parents who live in poverty, they don't have a lot of time. They often have to work multiple jobs. They're really stressed out. There's financial adversity at home and that can lead to being unable to spending more time with their kids, reading before bed, or being able to afford toys and books and things like that. So you have stress and stimulation. I would say these are the two things that we're capturing through family stress and family investment. So you have higher levels of stress and you have lower levels of cognitive stimulation. And a third pathway could potentially be something called the scarcity mindset, which actually comes from economics research, which talks about how when you have a lot on your plate with things that are extremely immediate and urgent, like putting food on the table, being bullied at school, then your bandwidth is too taxed to be actually able to perform in cognitive tasks. And they've done loads of these studies in India with farmers pre and post harvest and a lot of other examples where they show that not having enough, so being scarce in a resource like money, can directly impact how you perform, the same person, how they perform on a cognitive task. So these are the two or three different ways, I would say. Thank you. And I suppose this would be a nice time to come on to intersectionality. So you've mentioned India a few times here but actually there could be other known inequalities. So we could think about the Global North and the Global South. But we can also think about ethnic groups within a country, single-parent families, children in care, special educational needs, for example. How do those things intersect with poverty with relation to achievement and children's development? Yeah, that's a really good question, one we didn't investigate in this study because we wanted to just focus on poverty in general, but I imagine that it would compound, as you said. Because if you have structural disadvantage in two different forms, they obviously likely have intersecting and compounding or additive effects on top of one another. So in an imaginary situation where you have a kid from a poor household who also has special education needs and those needs are not being met in their school, you can imagine that their achievement is definitely going to be more severely impacted than a kid who grew up in poverty but did not have those special education needs. And similarly, structural racism and teachers treating kids from minoritized backgrounds differently in school, that could also lead to similar compounding disadvantage. And it sits well with the scarcity model. Essentially, there's another challenge to what's going on for you and having to navigate that. Exactly. It's really interesting. And I like the way you were saying, well, hold on a minute. What is the pathway between-- and I'm going back to executive function. But just thinking about the impact, the potential impact that poverty can have on brain function, are there any data or would you hypothesise that if circumstances improved radically-- so, for example, a family moved and got out of a very stressful environment and moved into a much more protected environment and had economic security-- would you predict that their executive function in that child would improve, or is this a hypothesis that there's a critical period of executive function capacity that has less elasticity? I mean, no stress does impact on EF function minute to minute, but is there any data on longer term changes in circumstances? That is the hope is what I'll say. The brain is extremely plastic. So we start off with 25% of our brain volume when we're born. And we reach 90% of our brain volume when we're about six or seven. So there's a really long time in between for the environment to shape the brain, so to speak. But this reminds me of a study from the United States called the Moving to Opportunity study. And very briefly, what they did was they gave families vouchers that lived in disadvantaged neighbourhoods. And they could either use them to move to a more advantaged neighbourhood, or they could continue to live in the neighbourhood that they lived in. So for the families that actually took those vouchers and moved to a more advantaged neighbourhood, the kids did significantly better in long-term life outcomes but particularly for children who moved before the age of six. So the effects were the strongest earlier in childhood, which makes sense because the brain is the most plastic. It continues to be plastic and then you have this renewed period of brain plasticity in adolescence. So I think the answer to your question is, yes, it's malleable. I don't think any of these outcomes are fixed. And changes in circumstances will definitely help improve outcomes for kids who grow up in low-income households. So here, we're assuming that children's circumstances would improve. And I think in the past, that's been a reasonable assumption like the quality of life has been improving for lots of people. But recently, there have been lots of different problems in the world which have meant that you might have children who go the other way, who weren't necessarily living in poverty but then are now living in poverty. Is that more detrimental than always being in poverty or moving from poverty to not poverty in your view? Very interesting question. And I have to say I don't know the answer to that. So the thing is, unpredictability is like this new dimension of adversity that people have started looking at. But my intuition says that being in poverty constantly would be worse than someone who, in their formative years, did not spend time in poverty and then transitioned in. And I think those stresses would be different and there would definitely be impacts. But I think consistent poverty, we know is probably the worst. It's an interesting question though, isn't it? In terms of the bounce back and what the outcome would be and that variability and experience and would there be a lack of hope, I guess, that experience of that things might change rather than we are certainly in this very difficult circumstance, and that's where we're going to continue. Shall we think a little bit about resilience? Because that's a key part of your paper. And, Umar, I know you wanted. I don't want to dive in before, because I think you wanted to ask about resilience. And I've got a follow-up question after that. So I'll go first. You know, you're talking about resilience in this paper. It would be helpful to think about-- well, try and explain what resilience is. So what do you mean by resilience in the context of what you're doing here? And can children be taught resilience? How does it develop in children? Those kinds of things would be helpful to just unpack. So the definition of resilience is something that's quite, I want to say, up in the air. Because it's hard. It's a hard thing to pin down. But I think one way to operationalize it is to think about how kids are able to have the ability to maintain good outcomes despite having faced adversity. So that's what we defined it as. So we define it as children from low-income families who displayed above average cognitive function. And we labelled those children cognitively resilient because despite living in low-income households, they showed those outcomes. And that's only about 25% to 30% of low-income kids. To answer your question about whether they can be taught resilience, I'm not sure because I think resilience can be supported is what I'll say. I don't know if we can teach it, because it's not really just one thing. I think it's a trait plus circumstances and social support, having stability in the environment. A lot of these different things intersect and bring about resilience. But I do think we could teach children coping skills, emotion regulation, things like that in school environments. That could help potentially. But yeah, I think-- I mean, I want to say that, yes, I think you can support it, but I don't think you can teach resilience without also addressing structural disadvantage. Can you say a bit more about that? So I mean, I think that if we teach emotion regulation in schools but do absolutely nothing to alleviate poverty or to make people's circumstances better, then all we can do is then blame those individuals for not developing that resilience. But it's really challenging to be resilient or overcome all of those challenges without any support whatsoever. So I think the first thing that we have to do is remove those structural barriers, then support those kids. And in this multi-pronged approach, I think we can foster resilience and positive outcomes. And the idea of resilience is very interesting when it's described even, I think, in academic discussion but certainly in the general public. The idea of resilience is that a child or an individual will "bounce back" in inverted commas and be just as good as they ever were and the trajectory will continue in a very positive way. But actually, more often, what we mean by resilience is that there is a recalibration. And their trajectory might be different and maybe not as high because of that experience, but they have found some recovery in their trajectory. And I think that's very important, because the degree of disadvantage and that intersectionality that you were raising earlier, Umar, which could add up to far greater impacts and a far greater challenge to the resilience, is a really important part of understanding poverty precisely because there are so many variables that we're talking about. Yeah. And resilience has been examined in a couple of different ways. So could either say you're resilient, because you're doing better than peers who face the same risks so other kids who grew up in poverty. Or you could say you're only resilient if you're actually doing as well as peers who don't face the same risks. Also, these definitions, I think, also change how we are looking at it and what we find. Yeah so I just wanted to add that Yeah, I was frantically trying to find the name of the hypothesis that I'm thinking about and thinking about whether it applies here, but I couldn't find it. But I'll describe it and see if we can try and weave it in. I think it's by Mike Rutter and it's something like-- it's about inoculation. And so low levels of stress and adversity are considered important for children to be able to develop coping. It's called the stealing effect. And I think Mike's theory showed that moderate levels of adversity, so very mild forms of adversity, can actually foster good outcomes and life satisfaction in people. And I think it's a difference between acute and chronic stress. Exactly. So I think the Rutter hypothesis was more about having a very difficult time finding a coping strategy and then the rest of the world settling down, you having found a way through it and experienced the idea that I can get through a difficult event, I can find a way around it, and things will settle down. Whereas I think poverty and the challenges of poverty are chronic. And I think both from a neuroscience point of view but also I think in terms of other variables, I think it would be-- well, you tell me. I think it would be a different experience. I agree, and I think maybe for the purpose of this podcast, maybe we don't want to give the message that any level of poverty is OK so maybe we just-- yeah. Because I think you're right. Having brief spells of negative experiences. But then the moment it becomes chronic, the brain and body and other organ systems are all impacted. Shall we go back to another aspect of resilience and think about-- because I'm particularly interested in the emotional and social aspects that can support resilience. Now here, I'm of course standing on the shoulders of giants such as Ann Masten, who talked about that Ordinary Magic phenomenon, and we talked about it briefly at the beginning of our discussion, didn't we, before we turned the mics on. But can you describe some of the variables in that area of social and emotional development that you think might contribute to resilience? So in our study, we didn't have that many variables that reflect these things because working with a big data set and some of these things weren't measured or weren't measured very deeply. But I do think that social support is something that can really, really foster that resilience. So if you have mentors, if you have parents that are really supportive, if you have a teacher at school that-- if you have role models, those sort of things I think can really help children overcome some of these barriers that they face, even something as simple. I think if you look at the data and systematic reviews and all of that, one of the things is parental expectations for education. Something as simple as that is actually a really strong pathway that links disadvantage to lower outcomes. So that support that you might get in a high-income household where your parents are saying, I expect you to go to university or I expect you to go to medical school. Even just that, regardless of everything else about you, can make you overcome those barriers. You know what I mean? So I think that these social and emotional factors can play a really important role for sure. But this costs nothing, which is really interesting. So getting that idea across that your expectations should be just as high as everybody else, allowing parents to get hold of that information will be really important. And that's not a costly intervention. That is a public information piece of content that we must be able to share. And I think it's powerful, as you say. It's one piece of intervention, but potentially one that could change a young person's trajectory. So I think that what would be helpful here is if we think about the message here. So if we have some children who are living in poverty, what are some of the factors that would predict their resilience to that adversity, so that they can achieve in education and in terms of cognitive functioning as well? So in our study, we looked at it in three different levels. So we looked at individual level factors, some sort of family history and proximal environment and then also neighbourhood level factors. So I have to say some of those are much less intervenable, because we did find that high birth weight for example, is something that can promote resilience. Not sure how much we can intervene on that except by improving the support systems for pregnant women in low-income settings. But there are some that are directly intervenable like availability of physical activity opportunities, availability of visual and fine arts opportunities after school. So we found a range of different variables, some of which are good to know about, because it means that you can identify kids who are at risk. So you know that somebody who's born with a low birth weight despite being in the normal range may be at risk if they're from a low-income household to not be cognitively resilient. On the other hand, we're identifying factors that are definitely protective. So one was engagement in physical activity. Another one was engagement in visual arts. We found that living in concentrated privilege in a privileged neighbourhood is something that predicts cognitive resilience as well. We found that duration of breastfeeding is actually something that predicts cognitive resilience. And that is something that the World Health Organisation is constantly talking about. There's a lot of public messaging around this but maybe that is something that we can change. Sorry, do more of is what I meant. But taking all of this into account, I would say let's start where the evidence converges. So going to the economist Heckman curve phenomenon where you have the greatest return on investment if you invest in early childhood, I would say that is where we should be intervening. So high-quality child care, parenting support, and then we can have the next level later in childhood and adolescence where schools can be a really important lever by providing after-school programmes to be able to engage in both physical and non-physical activity, provide that social network that kids need that I think is reducing with all of the advent of digital media and everyone playing online and not talking to each other in person and then finally community programmes in your local neighbourhood where you can have maybe kids meet role models or maybe there's after-school clubs, something like that. So provide those things that are actually not that hard to organise in both neighbourhoods and schools. That's what I would say. What's so notable about every one of those interventions-- and I like the way you've gone from the individual to societal and all the way in between-- is that everybody would benefit from that. And of course, those that are more vulnerable will proportionately benefit to a greater degree. But information about breastfeeding or augmenting an educational experience, that has "a rising tide raises all the boats" experience. And so, it does feel somewhat frustrating. Of course, there's a cost associated, but there isn't a variability in the fact that some will lose and some will gain. Every young family would gain from those interventions. And I think again, though, some of those things, even though they are very intervenable like the duration of breastfeeding, it is, again, structural barriers that prevent that, because this data that we're using are from the United States where postpartum leave so maternity leave or parental leave is really dependent on the benevolence of your employer. It's not so much government mandated. So if you work in a job that doesn't give it to you, which is often when you're doing casual work or when you're not employed at a university like we are, then you're all the more at risk of not being able to do that. So some of these things exist not because people don't know about it or because they don't want to do it, but simply because they are unable to do it. So again, we have to go back again one step where that's structural intervention is the first thing that has to be done and then the public messaging. And when people know more about it, they can act on these important factors. And what you're saying about early intervention actually has been shown recently. So there was a report by the IFS where they looked at the impact of Sure Start Centres. So these were one-stop shops in neighbourhoods that brought together health services, parenting support, early learning, that kind of stuff. And I think what they found was that if you lived within a certain distance of a Sure Start Centre between the ages of zero and four, then your educational attainment improved compared to those who didn't at the age of like 7, 11 and 16. So just being in proximity to these centres, I think it assumed that people accessed that support was associated with increased educational attainment. You're describing the resilience factors as early intervention and then there's evidence that early intervention does work when it comes to educational attainment via this Sure Start Centre approach. I think it's just about making that case more loudly, more strongly, more widely so it's heard and then implemented. That's amazing. I didn't know about that so I'm going to go look this up right after. I can send it to you. I'll send it to you after this. That would be brilliant. Thank you. But, yeah, I mean, 100% early intervention has the largest return on investment. And even a lot of those neighbourhood factors that we found to promote resilience, it's not actually the neighbourhood factor itself because that's distal. What's happening in the neighbourhood, in a privileged neighbourhood is that there's better early child care centres. There's better primary schools. There's more children who, in the US, take AP classes, or advanced placement classes, which means children get to interact with other people that do the things that then model those behaviours in those kids which improves their final educational attainment as well. So it's like, in this case, a virtuous cycle if you live in an area where all of this is visible to you. People say, monkey see, monkey do. But I think it's also children see, children do. I think they model the behaviours and things they see around them. And also there's an implicit-- you were talking about expectation and the importance of that if that's in the family in narrative. But also there's an implicit expectation in the environment because there is a discussion and there's an aspiration to do whatever is happening in the peer group or teachers will talk about that career path and that changes your trajectory. I can imagine there's lots of ways in which the neighbourhood has an impact on young people's functioning. Yeah, it's fascinating. Thank you so much for your time and for that amazing conversation, Divyangana. It's just so helpful. And I think that it's been presented in such an accessible way and that if we've got people who this is not their area of expertise will gain a lot from this so thank you so much. Oh, you're welcome. It was a pleasure I love this conversation. Excellent. We did too. That was a really, really nice conversation there, Jane. I think what I particularly liked about that was how we could get into a very interesting and deep and serious topic without getting bogged down in the technical aspects of the study or the stats, but it's just this is an important topic and this is why and these are the mechanisms through which these things happen. And I thought that was really, really well done. Absolutely. And it raised-- because I think partly because of the nature of the data and the capacity to just underline some of the really key and well established data points that allow us to say, look, intervention is very clearly implied and required because we know that this is a strong finding. And we can see that, for example, early intervention in whatever context is indicated. It was brilliant. And when we saw this paper come up as an opportunity to have on the podcast, both of us jumped on it with two hands because it raises so many fundamental questions about support for young families. Yeah. And it gets to that point of-- I think where I am in my career at the moment. I'm very like, let's think about the social drivers or the social determinants of lots of the things that we're interested in as psychologists. And it's not about situating the problem within the individual. It's like, what's the environment of the child is growing up in? How is that impacting on their development? And some of that, there's a perception that when we talk about environment, we're talking about parenting or families. But actually, there's a broader context here. There's a broader societal context here about poverty and that's not just on the parent, that's on society as a whole and how we build a society that's less unequal, more equal so we have fewer children who are living in poverty and then we are-- And I think what's really nice about the conversation that we've had is Divyangana's research shows that early intervention is likely to improve on young people's cognitive outcomes and educational attainment. And then there's other evidence where there's a quasi-experimental type work that has demonstrated that that is the case so we know what needs to be done. We know. Absolutely. And it really does because I mean-- and it's interesting what you're saying about the, well, of course, psychology is our background in terms of our first degree. If you are thinking about these experiences-- one wants to think about sociology and economy and policy-- it really does draw you to think about the environmental experience, too. And certainly I know when I had a role in Hackney, which is one of the more socioeconomically-deprived areas, I think in the UK still, I think that still holds. But certainly when I was working there, a lot of my clinical work was about supporting ways of allowing the environment not to be so pernicious so helping families make an application for a loan or to think about how their housing was impacting on mental health and so on. And so it really did broaden out the intervention that was required by thinking about the environmental experiences as well as the individual experiences. It really did make me think very differently about the sort of interventions that might be required. So yeah, I think it's-- and we do, of course, that when we talked about this right at the very beginning that we know the impact that poverty has on mental health. It causes mental health problems. It also exacerbates in lots of instances, but it causes mental health problems. And we know from some emerging data that access to CAMHS, for example, is harder where there is low socioeconomic status. So in other words, you're more likely to have a problem and you're less likely to get the help too. And it really does speak to so many needs and challenges that we have. But we need to consider not just the environmental experiences, absolutely, oh, that we could be in charge of economic policy more. I think we have jobs to do but also to think about what-- as clinicians, you're thinking about the clinical impact, what we can do, because we've talked quite a lot about the risks today and the negatives, which we absolutely have to know about but these effects of poverty are so wide and deep. We can only think about a partial solution. But of course, that's better than no solution at all. And likely, most of our clinical work is about adding positive experiences to the system in terms of protection. And we've talked about them briefly, but it's worth underlining what we know about the evidence base for those young people living in poverty. If they have access to warm, consistent, and appropriately stimulating relationships with peers, parents, and/or teachers, these relationships act as buffers in terms of their mental health outcome but also their educational outcome. And as clinicians, very often, that's something that we can help in terms of messaging or indeed in terms of direct support to help with parenting interventions or social support and so on and so on. So there's so much to do. But as I say, that partial solution is one that we need to be at ease with. Do a little of something and that will make a small impact, but it might gather momentum over time. Yeah. I think my takeaway for academics is-- maybe it's two related points. But the first is the point that we made earlier in the podcast around-- we know that this is a resilience factor. We also know that the evidence is there, that this works if we intervene on this, but there's still a lack of policy change. So sometimes ACAMH policy change is not about a lack of evidence. It's a lack of political will, or it's not the right time or there isn't enough momentum like you mentioned. So whilst we're good at generating evidence and there's lots of pressure from higher education institutions to then generate impact, it can be difficult to do that when there isn't a will, there isn't momentum. The second point, which I wanted to finish on is around-- I gave a talk last week, I think it was, and it was about my research and it was about diagnostic labels. And I ended up talking about psychology but also the economics of education, the politics of education, sociology. And one of the guests was like, I did not expect this social science mix. But actually, that is what we need to be doing. So children do not grow up in a vacuum of just an individual or their family. They grow up in a society that then is influenced by economics, politics, sociology, all of those things so we should be thinking about how children develop within the context of all of those systems. That's so well said. But that breadth of understanding is fundamental, because it is complex so we need to understand from a wide perspective where this is coming from. I guess, for my-- I mean, my takeaway would be-- and maybe, Matt, this might be repetitious so you can edit this out if it is. But I would say that we can't address in a clinical context many of the established risks in terms of built environment or economy, but we can introduce positive moderators into the system and that can impact effectively a micro level. So this means educating adults around young people on the importance of and offering support with the development of warm and calm, enriching relationships. And that is an actionable takeaway. Thank you. 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